Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study.

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic. METHODS: This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes). RESULTS: After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91). CONCLUSIONS: Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.

Stress and substance abuse among workers during the COVID-19 pandemic in an intensive care unit: A cross-sectional study.

OBJECTIVE: Professionals working in intensive care units (ICUs) during the COVID-19 pandemic have been exposed to stressful situations and increased workload. The association between symptoms of traumatic stress disorders, substance abuse and personal/occupational characteristics of Brazilian COVID-19-ICU workers is still to be addressed. Our aim was to evaluate the prevalence of those conditions and to find if those associations exist. METHODS: In this observational, single-center, cross-sectional study, all professionals working in a COVID-19 ICU were invited to fill an anonymous form containing screening tools for traumatic stress disorders and substance abuse, and a section with questions regarding personal and occupational information. RESULTS: Three hundred seventy-six ICU professionals participated. Direct exposure to patients infected by COVID-19, history of relatives infected by COVID-19, and sex (female) were significantly associated with signs and symptoms of traumatic stress disorders. 76.5% of the participants had scores compatible with a diagnosis of traumatic stress disorders. Moreover, the prevalence of scores suggestive of Tobacco and Alcohol abuse were 11.7% and 24.7%, respectively. CONCLUSION: ICU workers had significantly elevated scores on both screening forms. Providing psycho-social support to ICU professionals may prevent future problems with traumatic stress disorders or substance abuse.

Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study. / Adesão a um protocolo de profilaxia de úlcera de estresse em pacientes críticos: estudo de coorte prospectiva.

OBJECTIVE: To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. METHODS: In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. RESULTS: Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. CONCLUSION: Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.

[Evaluation of the cold chain for vaccine conservation in primary healthcare centers in the South and Midwest regions of São Paulo city, Brazil, in 2011-2012]. / Avaliação da rede de frio para conservação de vacinas em unidades básicas de saúde das regiões Sul e Centro-Oeste do município de São Paulo em 2011-2012.

OBJECTIVE: to assess the cold chain capacity, health workers' immunobiological product conservation knowledge and practices in Primary Healthcare Centers (PHC) in São Paulo city, Brazil. METHODS: this descriptive study included 24 randomly selected PHC in the South and Midwest regions of the city; between December 2011 and July 2012, we interviewed the health workers on their vaccine conservation knowledge/practice and observed the local infrastructure, using a form developed for this project; we assigned points to items of the form and classified each PHC as sufficient, regular or insufficient. RESULTS: most of the 24 PHC evaluated were administered by Social Organizations; all of them had vaccine storage chambers; 5 PHC reported using their maximum storage capacity; 9 PHC were classified as having sufficient knowledge/practice and 15 as having regular knowledge/practice. CONCLUSION: in these PHC, cold chain utilization was close to its maximum capacity; many health workers did not have basic knowledge about vaccine conservation.

Avaliação da rede de frio para conservação de vacinas em unidades básicas de saúde das regiões Sul e Centro-Oeste do município de São Paulo em 2011-2012 / Evaluation of the cold chain for vaccine conservation in primary healthcare centers in the South and Midwest regions of São Paulo city, Brazil, in 2011-2012 / Evaluación de la cadena de frío para la conservación de vacunas en Unidades Básicas de Salud de las regiones Sur y Medio-Oeste de São Paulo en 2011-2012

OBJETIVO: avaliar capacidade da rede de frio (RF), conhecimento dos profissionais e práticas de conservação de imunobiológicos em unidades básicas de saúde (UBS) do município de São Paulo. MÉTODOS: estudo descritivo envolvendo amostra randômica de 24 UBS das regiões Sul e Centro-Oeste do município; de dezembro de 2011 a julho de 2012, foram entrevistados profissionais quanto ao conhecimento/prática em conservação de vacinas e observou-se a infraestrutura local, utilizando-se formulário desenvolvido para o projeto, sobre cujos itens atribuíram-se pontos e classificou-se cada UBS - suficiente, regular e insuficiente. RESULTADOS: a maioria das 24 UBS avaliadas era administrada por organizações sociais; todas possuíam câmaras de vacinas, cinco referiram utilizar sua capacidade máxima de armazenamento, nove UBS foram classificadas como de conhecimento/prática suficiente e 15 como de conhecimento/prática regular. CONCLUSÃO: a utilização da RF nessas UBS estava próxima da capacidade máxima; muitos profissionais não tinham conhecimentos básicos sobre conservação de vacinas.

OBJECTIVE: to assess the cold chain capacity, health workers' immunobiological product conservation knowledge and practices in Primary Healthcare Centers (PHC) in São Paulo city, Brazil. METHODS: this descriptive study included 24 randomly selected PHC in the South and Midwest regions of the city; between December 2011 and July 2012, we interviewed the health workers on their vaccine conservation knowledge/practice and observed the local infrastructure, using a form developed for this project; we assigned points to items of the form and classified each PHC as sufficient, regular or insufficient. RESULTS: most of the 24 PHC evaluated were administered by Social Organizations; all of them had vaccine storage chambers; 5 PHC reported using their maximum storage capacity; 9 PHC were classified as having sufficient knowledge/practice and 15 as having regular knowledge/practice. CONCLUSION: in these PHC, cold chain utilization was close to its maximum capacity; many health workers did not have basic knowledge about vaccine conservation.

OBJETIVO: evaluar la cadena de frío (CF), el conocimiento de los profesionales y las prácticas de conservación de vacunas en unidades básicas de salud (UBS) de São Paulo-SP, Brasil. MÉTODOS: estudio descriptivo de una muestra aleatoria de 24 UBS en las regiones Sur y Centro-Oeste del municipio; de diciembre del 2011 a julio del 2012, fueron entrevistados profesionales con respecto a sus conocimientos y prácticas en la conservación de vacunas, concomitantementese observó la infraestructura, utilizando un formulario desarrollado para el proyecto; atribuyéndose un puntaje específico para cada ítem, clasificamos las UBS como suficientes, regulares o insuficientes. RESULTADOS: la mayoría de las 24 UBS eran administradas por organizaciones sociales; todos tenían cámaras de vacunas; cinco informaron usar su capacidad máxima de almacenamiento; 9 UBS fueron clasificadas como suficientes y 15 como regulares. CONCLUSIÓN: la utilización de la CF en estas UBS estaba próxima al máximo; muchos profesionales no tenían conocimientos básicos acerca de conservación de vacunas.